Individual
KENYETTA COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CCM
Contact information
Practice address
36330 UNION LAKE RD APT 103, HARRISON TOWNSHIP, MI 48045-6643
(313) 433-3992
Mailing address
36330 UNION LAKE RD APT 103, HARRISON TOWNSHIP, MI 48045-6643
(313) 433-3992
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704277201
MI
163WC0400X
Case Management Registered Nurse
4704277201
MI
Other
Enumeration date
09/16/2017
Last updated
07/21/2022
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